Provider Demographics
NPI:1578675716
Name:EDDY, RALPH ROTHWELL JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:ROTHWELL
Last Name:EDDY
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 WHITE OAK ST
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-4770
Mailing Address - Country:US
Mailing Address - Phone:336-629-7095
Mailing Address - Fax:
Practice Address - Street 1:513 WHITE OAK ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-4770
Practice Address - Country:US
Practice Address - Phone:336-629-7095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC47621223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics